المؤلفون: Dulguerov, Filip, Abdurashidowa, Tamila, Christophel-Plathier, Emeline, Ion, Lucian, Gunga, Ziyad, Rancati, Valentina, Yerly, Patrick, Tozzi, Piergiorgio, Albert, Adelin, Ltaief, Zied, Rotman, Samuel, Meyer, Philippe, Lefol, Karl, Hullin, Roger, Kirsch, Matthias

المصدر: Interdisciplinary Cardiovascular and Thoracic Surgery, 38 (6) (2024-06-05)

مصطلحات موضوعية: Acute cellular rejection, All-cause mortality, Cardiac preservation solution, Heart transplantation, Inotropic score, Human health sciences, Cardiovascular & respiratory systems, Sciences de la santé humaine, Systèmes cardiovasculaire & respiratoire

الوصف: [en] OBJECTIVES: The choice of the cardiac preservation solution for myocardial protection at time of heart procurement remains controversial and uncertainties persist regarding its effect on the early and midterm heart transplantation (HTx) outcomes. We retrospectively compared our adult HTx performed with 2 different solutions, in terms of hospital mortality, mid-term survival, inotropic score, primary graft dysfunction and rejection score.METHODS: From January 2009 to December 2020, 154 consecutive HTx of adult patients, followed up in pre- and post-transplantation by 2 different tertiary centres, were performed at the University Hospital of Lausanne, Switzerland. From 2009 to 2015, the cardiac preservation solution used was exclusively St-Thomas, whereafter an institutional decision was made to use HTK-Custodiol only. Patients were classified in 2 groups accordingly.RESULTS: There were 75 patients in the St-Thomas group and 79 patients in the HTK-Custodiol group. The 2 groups were comparable in terms of preoperative and intraoperative characteristics. Postoperatively, compared to the St-Thomas group, the Custodiol group patients showed significantly lower inotropic scores [median (interquartile range): 35.7 (17.5-60.2) vs 71.8 (31.8-127), P < 0.001], rejection scores [0.08 (0.0-0.25) vs 0.14 (0.05-0.5), P = 0.036] and 30-day mortality rate (2.5% vs 14.7%, P = 0.007) even after adjusting for potential confounders. Microscopic analysis of the endomyocardial biopsies also showed less specific histological features of subendothelial ischaemia (3.8% vs 17.3%, P = 0.006). There was no difference in primary graft dysfunction requiring postoperative extracorporeal membrane oxygenation. The use of HTK-Custodiol solution significantly improved midterm survival (Custodiol versus St-Thomas: hazard ratio = 0.20, 95% confidence interval: 0.069-0.60, P = 0.004).CONCLUSIONS: This retrospective study comparing St-Thomas solution and HTK-Custodiol as myocardial protection during heart procurement showed that Custodiol improves outcomes after HTx, including postoperative inotropic score, rejection score, 30-day mortality and midterm survival.

العلاقة: https://academic.oup.com/icvts/advance-article-pdf/doi/10.1093/icvts/ivae093/57955437/ivae093.pdfTest; urn:issn:2753-670X

الوصول الحر: https://orbi.uliege.be/handle/2268/319443Test

المؤلفون: M A Gobran, Ahmed Helmy Omar, A B Elkerdany, Y Elnahhas

المصدر: QJM: An International Journal of Medicine. 113

مصطلحات موضوعية: Heart transplantation, Randomization, business.industry, medicine.medical_treatment, Crystalloid solutions, Organ preservation solution, General Medicine, medicine.disease, Transplantation, Single dose regimen, Cardiac Surgery procedures, Anesthesia, Ventricular fibrillation, medicine, business

الوصف: Introduction Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant. Methods Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant. Results Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant. Conclusions Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::ca729b779bab871fd4b76a3c7ea5fdf9Test
https://doi.org/10.1093/qjmed/hcaa042.004Test

المؤلفون: Karen L. Hardinger, Jennifer L. Garber, Katelyn R. Richards, Jillian L. Descourouez, Catherine Korte

المصدر: American Journal of Health-System Pharmacy. 73:1829-1839

مصطلحات موضوعية: Brain Death, medicine.medical_specialty, Resuscitation, Tissue and Organ Procurement, Organ Preservation Solutions, 030204 cardiovascular system & hematology, 030230 surgery, Pharmacists, Organ transplantation, 03 medical and health sciences, Professional Role, 0302 clinical medicine, Pharmacotherapy, medicine, Humans, Organ donation, Hormone replacement therapy, Intensive care medicine, Antihypertensive Agents, Pharmacology, business.industry, Health Policy, Organ preservation solution, Anticoagulants, Tissue Donors, Transplantation, Donation, business

الوصف: Purpose This article reviews organ donor pathophysiology as it relates to medication use with the goal of maximizing the successful procurement and transplantation of donor organs. Summary The number of patients requiring organ transplantation continues to grow, yet organ donation rates remain flat, making it critical to appropriately manage each organ donor in order to ensure viability of all transplantable organs. The care given to one organ donor is tantamount to the care of several transplant recipients. Aggressive donor management ensures that the largest number of organs can be successfully procured and improves the organs’ overall quality. Hospital pharmacists are responsible for processing orders and preparing the medications outlined in donor management algorithms developed by their respective medical systems. It is important that pharmacists understand the details of the medications used in these protocols in order to critically evaluate each medication order and appropriately manage the donor. Typical medications used in organ donors after brain death include medications for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. Conclusion It is essential to provide optimal pharmacotherapy for each organ donor to ensure organ recovery and donation. Typical medications used in organ donors include agents for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::56ae82f635a979185099b2aeea4c0be9Test
https://doi.org/10.2146/ajhp150956Test